Background & Aims

We studied incidence and mortality trends of colorectal cancer (CRC) in 39 countries according to age, sex, and anatomic location (colon vs rectum).

Methods

We retrieved incidence data from registries from 36 countries. The registries included the following: Cancer Incidence in 5 Continents volumes I to XI; the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute; and the Nordic Cancer Registries from Europe. We obtained mortality data from 39 countries of the World Health Organization database. We evaluated average annual percentage changes in CRC incidence and mortality in the past decade using joinpoint regression analysis.

Results

From 2007 to 2016, 2006 to 2015, or 2005 to 2014, depending on the availability of the data, the incidence of colon cancer increased in 10 of 36 countries analyzed (all in Asia or Europe); India had the greatest increase, followed by Poland. All 10 of these countries have medium to high Human Development Index (HDI) scores. Six countries had a decrease in colon cancer incidence; these countries had the highest HDI scores; the United States had the greatest decrease, followed by Israel. Seven countries (including all countries from Northern America) had a decrease in incidence among persons older than 50 years. Eight countries had an increase in colon cancer incidence among persons younger than 50 years, including the United Kingdom and India. Countries with a decreased or stable incidence among persons 50 years or older but a significant increase in persons younger than 50 years, included Germany, Australia, the United States, Sweden, Canada, and the United Kingdom. Only Italy had a decrease in CRC incidence among persons younger than 50 years. Among women, 12 of 36 countries (all from Asia and Europe) had an increase in colon cancer incidence and 7 countries had a decrease; India had the greatest increase followed by Slovenia. Five of 36 countries had an increase in incidence of rectal cancer and 8 countries had a decrease; Ecuador and Thailand had the greatest increases in incidence. The incidence of rectal cancer among persons younger than 50 years increased significantly in Finland, Australia, Canada, the United States, and The Netherlands. Four countries had an increase in the incidence of rectal cancer in women; Ecuador had the greatest increase followed by Thailand. The incidence of rectal cancer in women decreased in 8 countries. Among women younger than 50 years, rectal cancer incidence increased, despite a decrease in women older than 50 years, in Costa Rica, Slovenia, Japan, Slovakia, Canada, and the United States there was an increase in incidence, although their elder population had a stable or decreased incidence. Twenty-four countries reported a reduction in CRC mortality, including North America, Oceania, and most European countries. Nevertheless, some countries from Asia, Latin America, and Southern Europe had significant increases in CRC mortality.

Conclusions

In an analysis of incidence and mortality databases from 39 countries, we found that the incidence of colon and rectal cancers has continued to increase in countries with medium to high HDI and in younger populations. Preventive strategies are needed for countries with increasing CRC and rectal cancer incidence and mortality.

中文翻译：

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基于性别、年龄和解剖位置的全球结直肠癌发病率和死亡率趋势差异

背景与目标

我们根据年龄、性别和解剖位置（结肠与直肠）研究了 39 个国家结直肠癌 (CRC) 的发病率和死亡率趋势。

方法

我们从 36 个国家的登记处检索了发病率数据。登记包括以下内容： 五大洲第一至十一卷的癌症发病率；国家癌症研究所的监测、流行病学和最终结果计划；和来自欧洲的北欧癌症登记处。我们从世界卫生组织数据库的 39 个国家获得了死亡率数据。我们使用联合点回归分析评估了过去十年中 CRC 发病率和死亡率的年均百分比变化。

结果

从 2007 年到 2016 年、2006 年到 2015 年或 2005 年到 2014 年，根据数据的可用性，所分析的 36 个国家中有 10 个（均在亚洲或欧洲）的结肠癌发病率增加；印度增幅最大，其次是波兰。所有这 10 个国家的人类发展指数 (HDI) 得分都为中到高。六个国家的结肠癌发病率有所下降；这些国家的人类发展指数得分最高；美国下降幅度最大，其次是以色列。七个国家（包括来自北美的所有国家）在 50 岁以上人群中的发病率有所下降。包括英国和印度在内的 8 个国家 50 岁以下人群的结肠癌发病率有所增加。50 岁或以上人群发病率下降或稳定，但 50 岁以下人群发病率显着增加的国家包括德国、澳大利亚、美国、瑞典、加拿大和英国。只有意大利的 50 岁以下人群的 CRC 发病率有所下降。在女性中，36 个国家（均来自亚洲和欧洲）中有 12 个国家的结肠癌发病率上升，7 个国家下降；印度增幅最大，其次是斯洛文尼亚。36个国家中有5个直肠癌发病率上升，8个国家下降；厄瓜多尔和泰国的发病率增幅最大。在芬兰、澳大利亚、加拿大、美国和荷兰，50 岁以下人群的直肠癌发病率显着增加。四个国家的女性直肠癌发病率有所增加；厄瓜多尔的增幅最大，其次是泰国。8个国家女性直肠癌发病率下降。在 50 岁以下的女性中，尽管 50 岁以上女性的直肠癌发病率有所下降，但在哥斯达黎加、斯洛文尼亚、日本、斯洛伐克、加拿大和美国，直肠癌发病率有所增加，尽管其老年人口发生率稳定或下降。24 个国家报告 CRC 死亡率下降，包括北美、大洋洲和大多数欧洲国家。尽管如此，来自亚洲、拉丁美洲和南欧的一些国家的 CRC 死亡率显着增加。8个国家女性直肠癌发病率下降。在 50 岁以下的女性中，尽管 50 岁以上女性的直肠癌发病率有所下降，但在哥斯达黎加、斯洛文尼亚、日本、斯洛伐克、加拿大和美国，直肠癌发病率有所增加，尽管其老年人口发生率稳定或下降。24 个国家报告 CRC 死亡率下降，包括北美、大洋洲和大多数欧洲国家。尽管如此，来自亚洲、拉丁美洲和南欧的一些国家的 CRC 死亡率显着增加。8个国家女性直肠癌发病率下降。在 50 岁以下的女性中，尽管 50 岁以上女性的直肠癌发病率有所下降，但在哥斯达黎加、斯洛文尼亚、日本、斯洛伐克、加拿大和美国，直肠癌发病率有所增加，尽管其老年人口发生率稳定或下降。24 个国家报告 CRC 死亡率下降，包括北美、大洋洲和大多数欧洲国家。尽管如此，来自亚洲、拉丁美洲和南欧的一些国家的 CRC 死亡率显着增加。和美国的发病率有所增加，尽管其老年人口的发病率稳定或下降。24 个国家报告 CRC 死亡率下降，包括北美、大洋洲和大多数欧洲国家。尽管如此，来自亚洲、拉丁美洲和南欧的一些国家的 CRC 死亡率显着增加。和美国的发病率有所增加，尽管其老年人口的发病率稳定或下降。24 个国家报告 CRC 死亡率下降，包括北美、大洋洲和大多数欧洲国家。尽管如此，来自亚洲、拉丁美洲和南欧的一些国家的 CRC 死亡率显着增加。

结论

在对来自 39 个国家/地区的发病率和死亡率数据库的分析中，我们发现结肠癌和直肠癌的发病率在 HDI 中高的国家和年轻人群中持续增加。CRC 和直肠癌发病率和死亡率不断增加的国家需要采取预防策略。